Head and Neck Outreach in Uganda

Akina Tamaki, MD; Shawn Li, MD; Chad A. Zender, MD

The Head and Neck Outreach (HNO) team was established in 2014 through a partnership between Case Western Reserve University, University Hospitals Cleveland Medical Center, the Uganda Cancer Institute (UCI), and Makerere University School of Medicine. Since HNO was established, medical outreach trips to Uganda have been conducted on a semiannual basis under the leadership of Chad A. Zender, MD. During this period, over 200 patients have been evaluated and over 100 have undergone surgical treatment of head and neck ailments.

Figure 1: HNO team consisting of physicians from the United States and Uganda. From left: Drs. Fred Bisso, Chad Zender, Isaac Mukiibi, Judith Tuhaise, Idress Kabezzi, Jeffrey Otiti, Ian Bwete, Fiona Kabegenyi, Shawn Li, and Akina Tamaki.

I had the privilege of participating in the program during May 2018. This year’s team of ten from the United States consisted of otolaryngologists, anesthesiologists, a pathologist, a medical student, and nurses. In addition, upon arrival to Uganda, we were met by the local team of otolaryngology attendings and residents, anesthesia providers, as well as surgical nurses affiliated with the UCI and Makerere University. HNO has established a close relationship with Ugandan ENT physicians and residents, and a large part of our initiative includes working alongside these local providers to educate and create infrastructure for high level head and neck care.

Figure 2: Dr. Chad Zender operating with members of the HNO team.

In the past, surgical trips have taken place in Kampala, the capital and largest city in Uganda. This year, for the first time, we made the four-hour drive from the capital to the city of Mbale. After an afternoon of unpacking, we went straight into daily clinics and operations. We attempted to see as many of the patients who formed the long line outside of the clinic. Many patients traveled for hours or even days to be seen. Apart from our new clinic patients, several dozen patients were prescreened by the Ugandan providers for surgery. The patients ranged from children to the elderly, with a wide range of pathologies including head and neck cancers, congenital malformations, tracheal stenosis, and thyroid or parotid masses.

One of the daily highlights was rounding on post-operative patients. The wards consisted of about 30 beds lined up in a row. Each patient and their family would occupy a three-by-six feet space that included a bed, floor mats, and, if lucky, mosquito nets brought in by the families. One of the most unique aspects of the wards was how dedicated families were in care of not only their loved ones, but of the neighboring patients. As we rounded on each patient, members of surrounding families would help translate, reinforce drain care teaching, and assist in any way needed. This spirit of camaraderie was present throughout the entire trip as every member was deeply invested in the care of each patient.

Thank you to the AAO-HNS Foundation for the generous travel grant and giving awareness to endeavors such as HNO. This opportunity to participate in the Uganda medical outreach trip was invaluable to my education and helped solidify my desire to make humanitarian work a significant part of my career.